Dr. Roach: You need information for informed decision

Keith Roach
To Your Health

Dear Dr. Roach: I am an active 83-year-old man with health issues that include Type 2 diabetes, diverticulitis surgery, bladder cancer and an enlarged prostate. The urologist said I have a small lump on my enlarged prostate and recommended a biopsy, which I am against.

If it’s slow-growing, fine; if not, little can be done at my age anyway.

What do you say?

E.S.

Dear E.S.: While I understand your point, I don’t think I agree with you. A prostate mass is something you should know more about. It’s better to make a decision knowing as much as you can, and the risk from a biopsy is small. There certainly are treatment options that are appropriate for an 83-year-old man.

Of course, it is your body and your decision, but my opinion is that knowing more can only improve your ability to make a decision about whether to treat.

Dear Dr. Roach: I am a 65-year-old woman and have been on valsartan, 160 milligrams, for hypertension for many years. My blood pressure has been under control with medication, in the 120-140/80-95 range most of the time.

I had one episode each in 2013 and 2014 with spikes of 175/105 and 212/110, respectively. The emergency room where I ended up did tests and released me after four hours when no damage was found in my organs and my blood pressure came back to the 160/95 range.

I would like to understand the reason for these spikes.

My doctor said that the cause is stress. However, when discussing this with a co-worker, she suggested that I seek a second opinion, and said that multiple sclerosis or my gallbladder could be the issue here.

What is your take on the potential causes of these spikes? Should I be asking for other diagnostic tests, and what might they be?

D.C.

Dear D.C.: Spikes in blood pressure can be physiologic — that is, a normal response to stress or other stimuli — but your numbers are concerning. Erratic blood pressure in multiple sclerosis is not uncommon, but the pressures tend to go lower, not higher. I can’t think of how gallbladder problems would cause high blood pressure in absence of pain.

In any event, neither of these is a common cause of blood pressure spiking.

Periodic release of substances that raise blood pressure, especially in pheochromocytoma, classically cause a flushing sensation and BP spikes. Blockages of the arteries of the kidneys can as well. These are rare but serious, so it may be worth asking your doctor about them.

If your usual blood pressure can get as high as 140/95, it may be appropriate to add therapy. This may be a second medication, such as a diuretic, or nonpharmacological treatment.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.